Four cases of villous adenoma of rectum in our department : Comparative study of 88 cases of villous adenoma in Japan

We reviewed the charts of 4 patients with villous adenoma of the rectum seen at the First Dept. of Surg., Okayama Univ. Med. School between 1971 and 1990. This study included 2 men and 2 women, ranging in age from 52 to 83 years. Polypectomy was performed on 3 patients with villous adenoma and low anterior resection was performed on 1 patient. Recurrent tumors developed in one of the 3 patients who had undergone polypectomy. In addition, a series of 88 patients with villous adenoma of the rectum reported in Japan were also reviewed. The average age of the patients with villous adenoma was 62.9. There were 47 men and 41 women. The presenting symptoms of the 69 patients with tumor were mainly bleeding and watery or mucinous diarrhea. The tumor size and invasiveness of malignancy were also examined. The likelihood of malignancy correlated with size of tumor, and none of the lesions smaller than 2cm contained a malignant tumor site. Surgeons should consider the size, location and malignant change of the villous tumor with as much precise examination before and during operation so that unnecessary over surgery is avoided

Lymph node metastases of right colon cancer

The lymph node metastases of the right side colon were studied. Among 58 cases of right side colon, nodal involvements were found in 53.4%. Metastases to the epicolic and paracolic nodes were confined to an area within 10 cm from the tumor margin. Metastases to the intermediate nodes were found in 20.7% and metastases to the main nodes in 15.5%. Jumping metastases were recognized in 5 out of 31 cases of nodal involvement (16.1%). As the rate of jumping metastases is unexpectedly high, lymph node dissection for right colon cancer should be done as far as the main nodes

A report of thirteen cases of familial polyposis coli

Familial polyposis coli (FPC) is an inherited nonsex linked mendelian dominant disease in which there exist at least 100 adenomatous polyps throughout the entire large bowel. Thirteen patients with FPC, of whom 7 were male and 6 female, visited our department between 1966 and 1990. The mean age of the patients was 33.5. Eight of the 13 patients (61.5%) had gastric and/or duodenal polyps, and eight of the 13 patients (61.5%) had colorectal carcinomas at admission. Colectomy with ileorectal anastomosis (IRA) was performed on 2 patients. The functional results were good bowel frequency, good sphincter control and lack of dietary restriction. Clinical experience tended to suggest that the risk of rectal cancer following IRA is extreme and unacceptable, although our two cases were still free of rectal cancer. Since 1980, the total colectomy with mucosal proctectomy and ileal pouch-anal anastomosis was the procedure of choice in our department. Good results were obtained on the six patients on whom this procedure was performed